N.H. Medicaid Called Lifeline

Health Service Urges Program’s Expansion

Claremont — The head of a top Upper Valley mental health organization has come out strongly in support of expanding Medicaid, arguing that the senate’s unwillingness to include funds to help pay for the expansion in its upcoming budget vote would be felt by many of the state’s most vulnerable.

Suellen Griffin, president and CEO of West Central Behavioral Health, said earlier this week that low-income families have too much hanging in the balance for the state to not take advantage of available federal funds. Her comments come as lawmakers continue to butt heads over whether to expand Medicaid coverage for up to 58,000 additional New Hampshire residents.

“Anything from a sudden death, to a divorce, to problems with children ... It impacts the entire family and they end up not being functional,” Griffin said. “They call us to get services and we treat them, regardless of their ability to pay, and we treat them for as long as we need to.”

But Griffin said the mental health outfit hasn’t received any help from the state in about a decade for treating patients who are uninsured or under-insured. She added that expanding Medicaid under the Affordable Care Act would supplement coverage for roughly 30,000 New Hampshire residents who use the mental health system and fall into one of those two categories.

West Central Behavioral Health is based in Lebanon and covers lower Grafton County along with all of Sullivan County, including Claremont and Newport.

A Senate finance panel voted last month to strip Medicaid expansion, which is a component of the Affordable Care Act supported by both Democratic Gov. Maggie Hassan and the Democratic-controlled House, from the budget. Two Upper Valley Republican Senators voted against the expansion, opting instead to establish a study committee for the expansion and revisit the issue in a year.

At a Statehouse news conference yesterday, Hassan sidestepped a question about whether she would expand the program without legislative approval, or veto a state budget proposal that did not include the expanded program.

“We are working with the senators of both political parties asking people to rise above political ideology to move forward with this. We need collaboration across the aisle in both chambers and in all branches of government,” she said.

The expansion is estimated to cost the state $85 million but would also bring as much as $2.5 billion in federal dollars to the state over the next seven years, but Senate Republicans have questioned whether those guarantees are reliable.

State Sen. Jeanie Forrester — a Meredith Republican whose district includes the towns of Haverhill, Dorchester, Piermont, Orford, and Orange — said that while she recognizes the need to improve access to health care — she also has plenty of reservations about the proposal to expand Medicaid.

Forrester said that she is still waiting for an answer on whether New Hampshire could pull out from the program if the federal government stopped covering its share.

“Even if we could, I’m not sure once we got into it that we would want to get out if it,” said Forrester. “Because how can you pull out an entitlement once its set in place?”

Forrester added that lawmakers should consider the worst-case scenario of the federal government leaving the entire tab to the state, and the question of how it would pay for the expansion under those circumstances.

“Are we prepared as a state to either cut services or raise taxes to pay for it?” asked Forrester. “That’s a big question for me.”

The expansion would allow anyone under the age of 65 who earns up to 138 percent of federal poverty guidelines — about $15,000 for a single adult — to enroll in Medicaid. The federal government would reimburse the state at full cost of the program for the first three years, and at 90 percent of the cost after that.

State Senate Majority Leader Jeb Bradley, R-Wolfeboro, issued a statement yesterday emphasizing that Medicaid is New Hampshire’s “largest and most expensive state program, costing $1.4 billion a year and accounting for 27 percent of the state’s general fund spending.

“Before New Hampshire rushes into a fundamental overhaul and expansion of this entitlement, practicality dictates that we study it carefully and consider our options,” Bradley said.

State Sen. Bob Odell, a Lempster Republican who represents the Newport area, also voted against the expansion. Odell did not immediately return calls for comment yesterday.

State Rep. Laurie Harding, a Lebanon Democrat and vice chairwoman of the Health, Human Services and Elderly Affairs Committee, described the Senate’s position as “misguided,” contending that the federal government has never failed to make Medicaid payments, even in times of fiscal stress.

“The other thing is that in order for the federal government to bail on this particular bill, it would take an act of Congress,” Harding said. “They can’t just decide not to continue the program.”

Harding acknowledged questions about how New Hampshire could implement a program that critics argue could be short-lived and underfunded, but she responded with a question of her own.

“If you were somebody who never had insurance, never had the ability to get treatment for your condition ... If you were offered one year of coverage, would you take that one year?” Harding asked. “My response is, of course they would take that one year ... To not give them the chance is not acceptable to me.”

Griffin said there was no way of telling how many more people West Central Behavioral Health would be able to serve under Medicaid expansion, due to uncertainty about how many more people would elect to receive help if they were eligible for Medicaid coverage.

She added that the expansion would allow for the treatment of substance abuse under Medicaid coverage, which New Hampshire does not currently allow but which is commonplace in other states, according to Griffin.

Despite the outcome of the Medicaid expansion, Griffin said she is cautiously optimistic about the future of the mental health system in New Hampshire, especially now that the Senate has indicated it would not cut any of the $28 million for mental health services included in Hassan’s budget for the next two years.

“I’m optimistic, I would use that word,” Griffin said. “I would not use ‘confident.’ ”

Given that the Senate majority has asked the Department of Health and Human Services to find $40 million in cuts, Griffin said it was hard to emit confidence.

But when asked if the Senate might shave funding from the $28 million designated for mental health in the upcoming budget negotiations, Forrester replied flatly, “No.

“We’ve been fully supportive of that in (the Senate Finance Committee) and I doubt that the Democrats would have a problem with that issue,” she said.

The New Hampshire-based nonprofit substance abuse prevention group New Futures will be holding a news conference on the topic of Medicaid expansion at 10 a.m. today at the Claremont Opera House, where Griffin will be an invited guest.

The issue of Medicaid expansion represents one of the last stumbling blocks that the House and Senate must overcome to solidify a budget before July. The Senate will vote on the state budget tomorrow.